Provider Demographics
NPI:1497156590
Name:CHRISTOPHER, CHRISEAN (LCPC)
Entity Type:Individual
Prefix:
First Name:CHRISEAN
Middle Name:
Last Name:CHRISTOPHER
Suffix:
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8620 W EMERALD ST STE 150
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704-4839
Mailing Address - Country:US
Mailing Address - Phone:208-617-3265
Mailing Address - Fax:208-617-3270
Practice Address - Street 1:8620 W EMERALD ST STE 150
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-4839
Practice Address - Country:US
Practice Address - Phone:208-617-3265
Practice Address - Fax:208-617-3270
Is Sole Proprietor?:No
Enumeration Date:2014-09-08
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LPC-5619101YP2500X
IDLCPC-8834101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional